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Crespo Pimentel B, Kuchukhidze G, Heyduk M, Thomschewski A, Trinka E, Höfler J. Ictal Cotard delusion as a manifestation of nonconvulsive status epilepticus: A case report and commentary. Epileptic Disord 2024. [PMID: 38686977 DOI: 10.1002/epd2.20221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/04/2024] [Accepted: 03/16/2024] [Indexed: 05/02/2024]
Abstract
Psychosis of epileptic origin can present a wide range of cognitive and affective symptoms and is often underrecognized. Usually occurring in the inter- and postictal phase, epileptic psychosis is mostly related to temporal lobe epilepsy. Here, we describe the clinical presentation and diagnostic workup including routine EEG recording and brain MRI of a 63-year-old woman expressing isolated nihilistic delusions comprising belief of being dead and denial of self-existence. EEG showed an ictal pattern fulfilling the Salzburg criteria of nonconvulsive status epilepticus and brain MRI revealed extensive peri-ictal hyperperfusion. Delusional symptoms and EEG abnormalities subsided after acute antiseizure treatment. Our case illustrates how nihilistic delusions can occur as a direct clinical correlate of seizure activity, thereby expanding the spectrum of ictal neuropsychiatric phenomena in temporal lobe epilepsy and highlighting the need to consider an epileptic origin in patients presenting with psychotic symptoms.
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Affiliation(s)
- Bernardo Crespo Pimentel
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Salzburg, Austria
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St. Peter, UK
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience Salzburg, Austria
| | - Marta Heyduk
- University Institute of Radiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience Salzburg, Austria
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Mendez MF. Cotard's Delusion From Subacute Encephalopathy With Seizures in Alcoholism. J Neuropsychiatry Clin Neurosci 2022; 35:202-205. [PMID: 36464976 DOI: 10.1176/appi.neuropsych.20220123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Mario F Mendez
- Departments of Neurology and Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, and Neurology Service, Neurobehavior Unit, U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
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3
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Couto RAS, Moreira Gonçalves L. A medical algorithm for Cotard delusion based on more than 300 literature cases. Int J Psychiatry Clin Pract 2021; 25:220-232. [PMID: 32935595 DOI: 10.1080/13651501.2020.1819335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Cotard delusion (CD) is a rare psychiatric disorder in which the patient believes to be dead, i.e., the patient holds nihilistic delusions concerning his/her own existence. Taking into account its rarity, and possible subdiagnosis due to unawareness, most of the literature consists of case studies, complicating a more systematic approach and leading to difficulties in deciding the best clinical guidance to offer the patient suffering from CD. The objective of this work is to review the literature and propose an algorithm to help the differential diagnosis and the management of this condition. METHOD To do so, an extensive literature research was performed using several bibliographic databases. Since data on this topic is scarce, references in every article were cross-checked, aiming to obtain all available peer-reviewed works on CD. RESULTS Research resulted in 328 cases. Several treatment modalities were reported to improve the symptoms of CD, from pharmacotherapy - mainly consisting of antipsychotics and antidepressants - to electroconvulsive therapy. CONCLUSIONS Despite its challenging diagnosis, the delusion can be treated with readily available care. Hopefully, this work can be a useful tool to doctors when encountering this odd affliction.
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Affiliation(s)
- Rosa A S Couto
- School of Medicine, University of Minho, Braga, Portugal.,REQUIMTE, LAQV, Laboratory of Applied Chemistry, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Luís Moreira Gonçalves
- Departamento de Química Fundamental, Instituto de Química, Universidade de São Paulo (USP), São Paulo, Brazil
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Tomasetti C, Valchera A, Fornaro M, Vellante F, Orsolini L, Carano A, Ventriglio A, Di Giannantonio M, De Berardis D. The 'dead man walking' disorder: an update on Cotard's syndrome. Int Rev Psychiatry 2020; 32:500-509. [PMID: 32500801 DOI: 10.1080/09540261.2020.1769881] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In 1880, Jules Cotard described a peculiar syndrome after observing the case of a 43-year-old woman, which was characterized by melancholic anxiety, delusions of damnation or possession, a higher propensity to suicide ideation and deliberate self-harm, analgesia, hypochondriac thoughts of non-existence or ruin of several organs, of the whole body, of the soul, of divinity, and the idea of immortality or inability to die. Several expansions and reinterpretations have been made of the so-called Cotard's syndrome, which is often encompassed in different neurological and psychiatric disorders, complicating and worsening their symptomatic frameworks and making more difficult their treatments. However, the nosographic characterization of Cotard's syndrome remains elusive and is not now classified as a separate disorder in both ICD and DSM-5. Here, we try to give an update, as well as a putative systematization, of current views and opinions about this nosological entity in the light of the recent progress in the clinic, psychopathology and psycho-neurobiology.
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Affiliation(s)
- Carmine Tomasetti
- Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, NHS, Hospital "Maria SS dello Splendore," ASL 4, Giulianova, Italy
| | | | - Michele Fornaro
- Department of Psychiatry, Federico II University, Naples, Italy
| | - Federica Vellante
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Department of Clinical Neurosciences/DIMSC, Section of Psychiatry, Polytechnic University of Ancona, Ancona, Italy
| | - Alessandro Carano
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "Madonna Del Soccorso", San Benedetto del Tronto, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Domenico De Berardis
- Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, NHS, Hospital "G. Mazzini," ASL 4, Teramo, Italy
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Pottkämper JCM, Hofmeijer J, van Waarde JA, van Putten MJAM. The postictal state - What do we know? Epilepsia 2020; 61:1045-1061. [PMID: 32396219 PMCID: PMC7317965 DOI: 10.1111/epi.16519] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
This narrative review provides a broad and comprehensive overview of the most important discoveries on the postictal state over the past decades as well as recent developments. After a description and definition of the postictal state, we discuss postictal sypmtoms, their clinical manifestations, and related findings. Moreover, pathophysiological advances are reviewed, followed by current treatment options.
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Affiliation(s)
- Julia C M Pottkämper
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jeannette Hofmeijer
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Michel J A M van Putten
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
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